Don’t be sorry: Hospitals need climate of safety to prevent needlesticks
Management support closely linked to safe practices
Creating a strong safety climate at your hospital may be even more important than the selection of safety devices in preventing needlestick injuries.
When employees perceive strong support from managers for safety and receive safety-related feedback, they are half as likely to experience blood or body-fluid exposures, according to research at the Johns Hopkins University in Baltimore.1
Health care workers who said that their workplaces were clean and orderly were three times more likely to report that they strictly adhered to safe work practices. Senior management support was also strongly linked to safe practices.
"The work environment is very important to frontline health care workers," says Robyn Gershon, MHS, DrPH, lead author of the article in the American Journal of Infection Control. Gershon, formerly at Johns Hopkins, is now assistant professor of sociomedical sciences in the School of Public Health at Columbia University in New York City.
"It’s a very social environment," she says. "How [colleagues and supervisors] do things and how they perceive things rubs off on you. You have to count on each other."
In fact, other industries have been quicker to embrace the idea of a safety climate, notes Jim Grosch, PhD, MBA, a research psychologist with the National Institute of Occupational Safety and Health in Cincinnati. "Outside of health care, safety-climate work has been [a focus] for a long time," he says. "It’s pretty well acknowledged that it makes a big difference in how employees and management view the workplace."
What is a safety climate and how do you assess it? Gershon and colleagues developed a 20-item survey to measure employee perceptions of the safety climate. The survey could be used easily in a hospital setting, she says. "I think it’s imperative that they take the pulse of their employees periodically so they know where they can make improvements."
In her research, Gershon administered a longer survey tool to health care workers, receiving 789 responses — 75% of them from nurses. The health care workers reported almost universal compliance with some standard precautions, such as proper disposal of sharps and wearing disposable gloves.
But the survey highlighted some common, unsafe practices. More than 30% of respondents reported at least occasionally recapping needles that had been contaminated with patients’ blood, and about 40% said they sometimes unscrewed used needles from needle holders. Both practices can lead to needlestick injuries.
Recapping may be an instinctive response from some health care workers who don’t want to walk with an unprotected needle or place an exposed one on a tray, says Gershon. Conveniently placed disposal containers and retractable devices offer an equipment-based solution. But strong messages about the work practices that lead to needlesticks also can change behavior, she notes.
Employees will perceive strong managerial support if managers consistently follow safe practices and insist that frontline workers do so as well, says Gershon. They should monitor injuries and needlestick incidents and report those levels to employees through newsletters or memos, she says. Managers should emphasize safety at staff meetings and through special seminars or programs.
Knowledge about bloodborne pathogens and training in safe practices isn’t enough, points out Grosch. "[Research shows] the factors that seemed to be most predictive of safety were organizational factors — the degree to which management takes safety seriously."
Something as simple as maintaining neat and clean workstations helps create a safety climate.
"One of the hospitals I worked with would hold spring and fall cleanup days," says Gershon. "[Administrators] would put out Dumpsters. Throughout the three shifts, people would just clean. You can make it kind of fun, with doughnuts and coffee. You would be amazed at what comes out of the woodwork when you do that."
Safety rounds or checks also can promote a rigorous enforcement of safe practices. At Holy Cross Hospital in Silver Spring, MD, multidisciplinary teams conduct a review of each department. They visit patient care areas at least twice a year and nonpatient care areas at least once a year. Any problems that are detected are fixed promptly.
The reviews are based on the Environment of Care standard from the Joint Commission on Accreditation of Healthcare Organizations, as well as guidelines and standards from other organizations. In the past two Joint Commission surveys, the hospital has received no Type 1 recommendations in the Environment of Care area, says Martha J. Grimes, RN, CIC, director of infection control and employee health services at Holy Cross.
The surveys pay off in other ways that are less obvious, she notes. They show that management truly cares about safety. "You have to invest time, money, and manpower in a program," she says. "If you don’t invest time, money, and manpower, then it’s just words."
Gershon’s safety climate survey is one way for managers to find out how employees perceive their work environment. Gershon recommends distributing the survey at work and providing mail-back envelopes or asking employees to fill them out on the spot at a staff meeting. The goal
is to get a high level of completion, at least 60%, while keeping the responses confidential, she says.
Managers should use the surveys to create improvement projects. If you don’t know where to start, just ask the employees, suggests Gershon. "One way you can really get to the heart of it is to hold some focus groups. You can always ask at the end of the questionnaire, What suggestions do you have?’ People are thrilled to tell you."
Just conducting a survey on safety can send a message that the hospital cares about the work environment.
(For more information on the safety survey, contact Robyn Gershon, 600 W. 168th St., Fifth Floor, New York, NY 10032. E-mail: rg405@columbia. edu.)
Reference
1. Gershon RRM, Karkashian CD, Grosch JW, et al. Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. Am J Infect Control 2000; 28:211-221.
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